Cranialization of the Frontal Sinus for Secondary Mucocele Prevention following Open Surgery for Benign Frontal Lesions

Abstract

ObjectiveTo compare frontal sinus cranialization to obliteration for future prevention of secondary mucocele formation following open surgery for benign lesions of the frontal sinus.Study DesignRetrospective case series.SettingTertiary academic medical center.PatientsSixty-nine patients operated for benign frontal sinus pathology between 1994 and 2011.InterventionsOpen excision of benign frontal sinus pathology followed by either frontal obliteration (n = 41, 59%) or frontal cranialization (n = 28, 41%).Main Outcome MeasuresThe prevalence of post-surgical complications and secondary mucocele formation were compiled.ResultsPathologies included osteoma (n = 34, 49%), mucocele (n = 27, 39%), fibrous dysplasia (n = 6, 9%), and encephalocele (n = 2, 3%). Complications included skin infections (n = 6), postoperative cutaneous fistula (n = 1), telecanthus (n = 4), diplopia (n = 3), nasal deformity (n = 2) and epiphora (n = 1). None of the patients suffered from postoperative CSF leak, meningitis or pneumocephalus. Six patients, all of whom had previously undergone frontal sinus obliteration, required revision surgery due to secondary mucocele formation. Statistical analysis using non-inferiority test reveal that cranialization of the frontal sinus is non-inferior to obliteration for preventing secondary mucocele formation (P<0.0001).ConclusionCranialization of the frontal sinus appears to be a good option for prevention of secondary mucocele development after open excision of benign frontal sinus lesions.

Orbitozygomatic Craniotomy via an Eyebrow Incision: Management of the Opened Frontal Sinus

“…Horowitz et al looked at the rate of secondary mucocele formation for open surgeries of benign frontal sinus pathology and compared frontal sinus obliteration to frontal sinus cranialization. 12 Total 6 of 69 patients developed a secondary mucocele and the average time to development was 4.3 years, range of 1 to 9 years. These six patients all had originally undergone obliteration of the frontal sinus following surgery for the benign pathology.…”

“…Frontal sinus mucocele is a long-term complication of entry into the frontal sinus. [10][11][12] There are few papers looking at the rate of secondary mucocele after surgery based on rarity and long follow-up needed. Horowitz et al looked at the rate of secondary mucocele formation for open surgeries of benign frontal sinus pathology and compared frontal sinus obliteration to frontal sinus cranialization.…”

Management and Surveillance of Frontal Sinus Violation following Craniotomy

“…The proposed method of surveillance parallels the recommendations for surveillance of frontal sinus fracture repair. [9][10][11] Furthermore, follow-up with an otolaryngologist to perform nasal endoscopy and review imaging may help prevent complications from mucocele formation, such as orbital and intracranial infections.…”

An Effective Method of Frontal Sinus Reconstruction After Bifrontal Craniotomy: Experience with 103 Patients

“…Various methods have been employed for reconstruction of the anterior skull base, including cranialization and obliteration of the FS (3,11,16,23,24,30). Cranialization involves elimination of the posterior wall of the FS, meticulous removal or coagulation of the FS mucosa, and allowing the frontal lobe to rest against the anterior table and floor of the FS (11).…”

“…Cranialization involves elimination of the posterior wall of the FS, meticulous removal or coagulation of the FS mucosa, and allowing the frontal lobe to rest against the anterior table and floor of the FS (11). Obliteration involves permanent occlusion of the frontal recess and physical obliteration of the FS (11). Numerous methods for obliteration of the FS have been reported, including the use of fat, fascia, muscle, galeal or pericranial flap, bone, and titanium plates (2-4, 6, 8, 11, 16, 23-25, 30).…”